Using the Radiographic "Platinum" Standard to Improve Footcare

Written for the International Equine Veterinarian March/April 2013 Issue by R.F. (Ric) Redden, DVM

Radiographs are an essential part of most physical exams of the lower limb and foot, whether the focus is a pre-purchase, exam or soundness issue. Veterinarians are responsible, licensed and required by state law to take and interpret radiographs, make a diagnosis and formulate a treatment plan, which is a straightforward process that does not require the input of other professions until the exam is focused on the foot.

Farriers share a significant responsibility for the overall health of the foot in spite of having limited or no formal education in farrier services or veterinary medicine, and are expected to maintain strong, healthy feet, prevent imbalance and its ill effects and treat and correct many commonly occurring problems that can threaten the career or even life of the horse. Veterinarians, even though licensed to treat the foot, as a rule have very limited or no farrier experience or skill however are expected to have as much working knowledge of the foot as the farrier and vice versa. Caring for the equine foot is an overlapping, duel responsibility that requires a totally different mindset, level of knowledge and skill that encompasses the basic principles of each profession.

Veterinarians and farriers who accept the responsibility of treating career and life threatening foot problems need to take this responsibility very seriously and constantly strive to strengthen the weak areas of their respective knowledge branch and experience. Radiographic information is the missing link that can help bring farriers and veterinarians to the same page. By taking the standard recommended radiographic views a step further and educating farriers to read and understand radiographic information, we develop a "platinum" standard of care that can increase the accuracy and degree of information a vet/farrier team can use to improve their ability to care for the foot.

Bridging the gap with platinum standard radiographs

The farrier with years of extensive experience trimming, shoeing and forging develops an eye for detail that can only be gained through hands on day in and day out. However the most valuable information is most often not available and many have not had the opportunity to work with veterinarians willing and eager to teach basic radiographic interpretation. Therefore they are limited at best when attempting to sort out an internal problem by altering the shape and balance of the capsule.

Developing my exclusively equine podiatry practice and clinic three decades ago led me on a pursuit for knowledge and success with a multitude of career and life threatening foot syndromes. Every case demanded more and more information, better interpretive skills, improved planning and better execution of the plan. I had to develop a more meaningful approach to gathering radiographic information that would give me answers to questions raised by routine radiographic views. This search opened my eyes to the mechanical formula that is the direct link from film to rasp, and how important it is to understand the effect internal structures of the foot have on the outside.

The next step is teaching this information to other veterinarians and farriers. Putting everyone on the same page allows us to develop common goals and an efficient way to achieve them. Simply put, veterinarians and farriers who study together can greatly enhance their knowledge and perception of the radiographic information they need to make it happen. What follows is confidence and understanding: the hallmarks of success.

Designing and utilizing the platinum standard

Standard, recognized radiographic views are informative but limited relative to the information required to understand the mechanical requirements of a foot. Beam orientation and other factors affect specific areas of interest. Therefore we must modify our protocol in order to get the most accurate film with the best information to base our interpretation and decision making from. I refer to this consistent, dedicated protocol as the 'platinum' standard of hoof care.

The farrier friendly lateral view:

• Beam orientation is crucial for accurate measurement of soft tissue parameters that are of the greatest concern. The primary beam should strike the hoof in a horizontal plane between the palmar rim and ground surface and perpendicular to the sagittal plane. Lining up the heel bulbs works well when they are relatively symmetrical. Proper beam orientation will reveal one branch of the shoe, as the primary beam superimposes one over the other.

• Zero film/subject distance minimizes magnification.

• Opaque wall marker (paste preferred) from the hairline of the coronary crest to the toe is required for traditional as well as digital film to assure accurate horn-lamellar (HL) zone and coronary/extensor process (CE) measurements.

• Both feet should be placed on blocks in their natural stance regardless of conformation.